Effect of a Fortified Balanced Energy-Protein Supplement on Birth Outcome in rural Burkina Faso.

The department of Food Technology, Safety and Health of the Faculty of Bioscience Engineering, Ghent University is engaged in a research on nutrition during pregnancy and lactation in Burkina Faso.

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20 Million children with low birth weight

Every year, 20 million children are born with a low birth weight, with increased risk for mortality, illness and impaired growth at a young age, and increased susceptibility to type 2 diabetes, hypertension and coronary heart disease later in life. Although healthy nutrition during pregnancy is crucial for the health of both mother and child, many women in the global south have insufficient access to it.

Starting from 2018, Ghent University will investigate whether an enriched food supplement during pregnancy and lactation improves birth outcomes and growth of children in Burkina Faso.

The department received a grand from the Bill and Melinda Gates Foundation to provide the necessary evidence to strengthen the WHO recommendation for the provision of balanced energy-protein (BEP) supplements in pregnant women in undernourished populations.

Randomized Controlled Clinical Trial

A BEP supplement provides less than 25% of protein of the total energy content, and includes different vitamins and minerals. The first part of an exploratory study will determine which type of BEP supplement (bar, drink, biscuit, soup or paste) is most accepted by pregnant women. Subsequently, two products will be tested for longer-term acceptability and at-home use (phase 1).

The effect of the most suitable supplement will be tested in a controlled clinical trial (phase 2). The intervention group will receive the dietary supplement during pregnancy and/or lactation, while the control group complies with the standard iron and folic acid tablets following the national guidelines.

Project History

The present MISAME study (MIcronutriments pour la SAnté de la Mère et de l’Enfant), is the third in a row to elucidate the relationship between maternal nutrition and birth outcome, infant growth and morbidity.

The first trial, MISAME-I, NCT00642408, started in 2002 in Houndé, the district capital of the province of Tuy in the midwest area of Burkina Faso. It was an individual randomised controlled trial (RCT) comparing the effect of a multivitamin-mineral supplement to iron/folic acid, the regular supplementation provided through government programs, during pregnancy.
The villages were spread around the health centers of Koho and Karaba. Overall, birth weight increased significantly in the intervention group, however, the difference with the control group was small. Results can be found in the publications of the trial: see MISAME publication list.

The second study, MISAME-II NCT00909974, took place in the same area and in the same health centres. The individual RCT compared the effect of the multi-vitamin-mineral supplement to a lipid-based food supplement enriched with the same dose of minerals and vitamins. The results again showed an improvement in birth weight, small for gestational age and prematurity, but again the effects were small. Given that the effect of the multi vitamin-mineral supplement was limited, the hypothesis was that energy might be the additional limiting factor. The papers of the trial provide more detailed information on results: see MISAME publication list.

In the present and third trial, MISAME-III, we supplement pregnant and lactating women with a balanced energy protein (BEP) food supplement, including a range of minerals and vitamins in the same study area.  

MISAME-I & II received financial support of the Flemish University Council (VLIR), the Belgian Cooperation and Nutrition Third World.